Head injury

If it’s a yes to any of this checklist, make sure the person you’re looking after gets to hospital:

• Have been knocked unconscious, even if they have since recovered
• Are finding it difficult to stay awake
• Clear fluid running from their ears or nose
• Bleeding from one or both ears
• Bruising behind one or both ears
• Any signs of damage to the skull or skin on the head, like a deep cut, bleeding or a dent
• They are intoxicated with drugs or alcohol
• Vomiting
• A seizure or fit

In relation to the mode of injury:

• It was caused by a forceful blow to the head or a knock at speed – this might be in an assault with a fist or weapon, a collision between car and pedestrian, bike or another car passenger
• They have fallen from a height of more than 1 metre or 5 stairs

If you know about the person’s background, they should go to hospital urgently if:

• They've previously had brain surgery
• They have problems with bleeding or clotting, either from a condition (like haemophilia) or medication (warfarin, apixaban, or rivaroxaban)
• You suspect a non-accidental injury, or this is a vulnerable person

Symptoms usually start within 24 hours, but can take up to 3 weeks to show, and may indicate concussion (a mild brain injury), a skull fracture, or a bleed in the brain.

You should get the injured person to the emergency department with urgency if any of the following manifests in the hours or days after the accident:

• Problems with walking or balance
• Weakness, numbness, or loss of sensation in any part of the body
• General weakness
• Changes to your eyesight
• A headache that doesn’t go away with painkillers
• Problems with speaking or understanding, and problems with reading or writing
• Problems with remembering events before or after the injury
• Behaviour changes such as being more irritable or short-tempereda, finding concentration difficult, or feeling no interest in things or people around them

Young children and babies can be difficult to assess, and their heads are more vulnerable as it takes time to develop the hard shell of skull we have as adults. All of the above applies, but particularly take notice of changes to behaviour – lacking interest in anything, crying more than usual.

If you didn’t feel someone needed to go to hospital, or they have been sent home from hospital with a minor head injury, make sure that you or another adult stays with them for at least the first 24 hours.

Paracetamol or ibuprofen may be used to relieve pain, and an ice pack (ice or a bag of frozen peas wrapped in a towel) can be held to the sore part of the head. This will also reduce any tissue swelling.

They need more rest than usual to recover, so let them sleep and avoid any stress.

School or work should be avoided until they feel well enough, and adults should avoid driving until fully recovered. Contact sports (or rough play for children) should be avoided for at least 3 weeks. Alcohol and drugs should be avoided until feeling better.